可乐定硬膜外给药对剖宫产患者术中应激反应的影响

Effects of Epidural Clonidine Administration on Stress Reaction in Parturients with Cesarean Section

目的 观察可乐定硬膜外给药对剖宫产妇应激反应的影响，探讨其可能的作用机制。方法 选择ASA Ⅰ或Ⅱ级须行择期剖宫产的孕妇40例，随机分为利多卡因组（L组）和利多卡因＋可乐定组（LC组）各20例。采用L1-2隙硬膜外穿刺，均给予2％利多卡因麻醉。待麻醉生效后，LC组一次性硬膜外腔注入可乐定，1ug·kg^-1。不同时点测定产妇疼痛视觉模拟评分（VAS评分）。并抽取不同时点产妇静脉血2mL和胎儿脐动静脉血各2mL，测定血浆肾上腺素、去甲肾上腺素和皮质醇含量。并于胎儿娩出后1和5min分别进行Apgar评分。结果 LC组VAS评分、血浆肾上腺素、血浆去甲肾上腺素和皮质醇含量均较L组明显降低（均P〈0.05），但两组新生儿Apgar评分差异无显著性。结论 可乐定联合硬膜外麻醉应用于剖宫产可降低产妇术中应激反应，对母婴均无不利影响。

Objective To observe the effects of epidural clonidine administration on stress reaction in parturients with cesarean section and to explore its possible mechanism. Methods Forty ASA grade Ⅰ orⅡ parturients scheduled for elective cesarean section, were randomly divided into two equal groups： group lidocaine （group L） and group lidocaine ＋ elonidine （group LC）. After L1 -2 epidural space puncture, 2% lidocaine was injected. After effective anesthesia, clonidine 1 μg . kg^-1 was administered epidurally. At different time points, Visual analog scale （VAS） scores were evaluated and 2 mL maternal venous blood and umbilical arterial and venous blood were collected respectively to measure the concentrations of epinephrine, norepinephrine and cortisol in plasma. Apgar scores were evaluated at 1 and 5 min after fetal delivery. Results VAS scores, epinephrine, norepinephrine and cortisol in parturients of group LC decreased significantly as compared with group L （P 〈 0.05 ）, but Apgar scores of neonates in two groups were not significantly different （ P 〉 0.05）. Conclusion Clonidine combined with epidural anesthesia can reduce the stress reaction of parturients during cesarean section with no side effects on the mothers and the neonates.